Kau Hospital

All Charges

Charge

Type

Setting

Price

TEMPLATE MINIRAIL KIT M225

Facility

$591.00

Hospital Revenue Code	272
Min. Negotiated Rate	$183.21
Max. Negotiated Rate	$573.27
Rate for Payer: AlohaCare Medicaid	$295.50
Rate for Payer: AlohaCare Medicare	$183.21
Rate for Payer: Cash Price	$354.60
Rate for Payer: Devoted Health Medicare	$200.94
Rate for Payer: Hawaii Medical Service Association Medicare	$183.21
Rate for Payer: Hawaii Western Management Group Commercial	$561.45
Rate for Payer: Health Management Network Commercial	$502.35
Rate for Payer: Humana Medicare	$183.21
Rate for Payer: Kaiser Permanente Commercial	$531.90
Rate for Payer: Kaiser Permanente Medicaid	$301.41
Rate for Payer: Kaiser Permanente Medicare	$183.21
Rate for Payer: MDX Hawaii PPO	$573.27
Rate for Payer: Ohana Health Plan Medicaid	$183.21
Rate for Payer: Ohana Health Plan Medicare	$183.21
Rate for Payer: UnitedHealthcare Medicare	$183.21
Rate for Payer: University Health Alliance Commercial	$430.78

TEMPLATE MINIRAIL KIT M225

Facility

$591.00

Hospital Revenue Code	272
Min. Negotiated Rate	$502.35
Max. Negotiated Rate	$573.27
Rate for Payer: Cash Price	$354.60
Rate for Payer: Health Management Network Commercial	$502.35
Rate for Payer: Kaiser Permanente Commercial	$531.90
Rate for Payer: MDX Hawaii PPO	$573.27

TENACIO ACCESSORY KIT

Facility

$2,970.00

Service Code	HCPCS C1813
Hospital Revenue Code	278
Min. Negotiated Rate	$920.70
Max. Negotiated Rate	$2,880.90
Rate for Payer: AlohaCare Medicaid	$1,485.00
Rate for Payer: AlohaCare Medicare	$920.70
Rate for Payer: Cash Price	$1,782.00
Rate for Payer: Devoted Health Medicare	$1,009.80
Rate for Payer: Hawaii Medical Service Association Medicare	$920.70
Rate for Payer: Hawaii Western Management Group Commercial	$2,079.00
Rate for Payer: Health Management Network Commercial	$2,524.50
Rate for Payer: Humana Medicare	$920.70
Rate for Payer: Kaiser Permanente Commercial	$2,673.00
Rate for Payer: Kaiser Permanente Medicaid	$1,514.70
Rate for Payer: Kaiser Permanente Medicare	$920.70
Rate for Payer: MDX Hawaii PPO	$2,880.90
Rate for Payer: Ohana Health Plan Medicaid	$920.70
Rate for Payer: Ohana Health Plan Medicare	$920.70
Rate for Payer: UnitedHealthcare Medicare	$920.70
Rate for Payer: University Health Alliance Commercial	$1,663.20

TENACIO ACCESSORY KIT

Facility

$2,970.00

Service Code	HCPCS C1813
Hospital Revenue Code	278
Min. Negotiated Rate	$1,663.20
Max. Negotiated Rate	$2,880.90
Rate for Payer: Cash Price	$1,782.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,079.00
Rate for Payer: Health Management Network Commercial	$2,524.50
Rate for Payer: Kaiser Permanente Commercial	$2,673.00
Rate for Payer: MDX Hawaii PPO	$2,880.90
Rate for Payer: University Health Alliance Commercial	$1,663.20

TENDON ANCHOR 8 2504-1

Facility

$2,700.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,512.00
Max. Negotiated Rate	$2,619.00
Rate for Payer: Cash Price	$1,620.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,890.00
Rate for Payer: Health Management Network Commercial	$2,295.00
Rate for Payer: Kaiser Permanente Commercial	$2,430.00
Rate for Payer: MDX Hawaii PPO	$2,619.00
Rate for Payer: University Health Alliance Commercial	$1,512.00

TENDON ANCHOR 8 2504-1

Facility

$2,700.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$837.00
Max. Negotiated Rate	$2,619.00
Rate for Payer: AlohaCare Medicaid	$1,350.00
Rate for Payer: AlohaCare Medicare	$837.00
Rate for Payer: Cash Price	$1,620.00
Rate for Payer: Devoted Health Medicare	$918.00
Rate for Payer: Hawaii Medical Service Association Medicare	$837.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,890.00
Rate for Payer: Health Management Network Commercial	$2,295.00
Rate for Payer: Humana Medicare	$837.00
Rate for Payer: Kaiser Permanente Commercial	$2,430.00
Rate for Payer: Kaiser Permanente Medicaid	$1,377.00
Rate for Payer: Kaiser Permanente Medicare	$837.00
Rate for Payer: MDX Hawaii PPO	$2,619.00
Rate for Payer: Ohana Health Plan Medicaid	$837.00
Rate for Payer: Ohana Health Plan Medicare	$837.00
Rate for Payer: UnitedHealthcare Medicare	$837.00
Rate for Payer: University Health Alliance Commercial	$1,512.00

TENDON GRACILIS SSG-002

Facility

$2,350.00

Service Code	HCPCS C1762
Hospital Revenue Code	278
Min. Negotiated Rate	$1,316.00
Max. Negotiated Rate	$2,279.50
Rate for Payer: Cash Price	$1,410.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,645.00
Rate for Payer: Health Management Network Commercial	$1,997.50
Rate for Payer: Kaiser Permanente Commercial	$2,115.00
Rate for Payer: MDX Hawaii PPO	$2,279.50
Rate for Payer: University Health Alliance Commercial	$1,316.00

TENDON GRACILIS SSG-002

Facility

$2,350.00

Service Code	HCPCS C1762
Hospital Revenue Code	278
Min. Negotiated Rate	$728.50
Max. Negotiated Rate	$2,279.50
Rate for Payer: AlohaCare Medicaid	$1,175.00
Rate for Payer: AlohaCare Medicare	$728.50
Rate for Payer: Cash Price	$1,410.00
Rate for Payer: Devoted Health Medicare	$799.00
Rate for Payer: Hawaii Medical Service Association Medicare	$728.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,645.00
Rate for Payer: Health Management Network Commercial	$1,997.50
Rate for Payer: Humana Medicare	$728.50
Rate for Payer: Kaiser Permanente Commercial	$2,115.00
Rate for Payer: Kaiser Permanente Medicaid	$1,198.50
Rate for Payer: Kaiser Permanente Medicare	$728.50
Rate for Payer: MDX Hawaii PPO	$2,279.50
Rate for Payer: Ohana Health Plan Medicaid	$728.50
Rate for Payer: Ohana Health Plan Medicare	$728.50
Rate for Payer: UnitedHealthcare Medicare	$728.50
Rate for Payer: University Health Alliance Commercial	$1,316.00

TENDONITIS, MYOSITIS AND BURSITIS WITH MCC

Facility

$19,767.47

Service Code	MSDRG 557
Min. Negotiated Rate	$19,767.47
Max. Negotiated Rate	$19,767.47
Rate for Payer: Hawaii Medical Service Association Commercial	$19,767.47

TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC

Facility

$19,767.47

Service Code	MSDRG 558
Min. Negotiated Rate	$19,767.47
Max. Negotiated Rate	$19,767.47
Rate for Payer: Hawaii Medical Service Association Commercial	$19,767.47

TENECTEPLASE 25 MG INTRAVENOUS SOLUTION [237629]

Facility

$10,457.00

Service Code	HCPCS J3101
Hospital Revenue Code	636
Min. Negotiated Rate	$171.94
Max. Negotiated Rate	$10,143.29
Rate for Payer: AlohaCare Medicaid	$5,228.50
Rate for Payer: AlohaCare Medicare	$3,241.67
Rate for Payer: Cash Price	$6,274.20
Rate for Payer: Cash Price	$6,274.20
Rate for Payer: Devoted Health Medicare	$3,555.38
Rate for Payer: Hawaii Medical Service Association ABD	$171.94
Rate for Payer: Hawaii Medical Service Association Commercial	$246.80
Rate for Payer: Hawaii Medical Service Association Medicare	$3,241.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$171.94
Rate for Payer: Hawaii Western Management Group Commercial	$9,934.15
Rate for Payer: Health Management Network Commercial	$8,888.45
Rate for Payer: Humana Medicare	$3,241.67
Rate for Payer: Kaiser Permanente Commercial	$9,411.30
Rate for Payer: Kaiser Permanente Medicaid	$5,333.07
Rate for Payer: Kaiser Permanente Medicare	$3,241.67
Rate for Payer: MDX Hawaii PPO	$10,143.29
Rate for Payer: Ohana Health Plan Medicaid	$3,241.67
Rate for Payer: Ohana Health Plan Medicare	$3,241.67
Rate for Payer: UnitedHealthcare Medicaid	$6,274.20
Rate for Payer: UnitedHealthcare Medicare	$3,241.67
Rate for Payer: University Health Alliance Commercial	$7,622.11

TENECTEPLASE 25 MG INTRAVENOUS SOLUTION [237629]

Facility

$10,457.00

Service Code	HCPCS J3101
Hospital Revenue Code	250
Min. Negotiated Rate	$8,888.45
Max. Negotiated Rate	$10,143.29
Rate for Payer: Cash Price	$6,274.20
Rate for Payer: Health Management Network Commercial	$8,888.45
Rate for Payer: Kaiser Permanente Commercial	$9,411.30
Rate for Payer: MDX Hawaii PPO	$10,143.29

TENECTEPLASE 50 MG INTRAVENOUS SOLUTION [206762]

Facility

$10,457.00

Service Code	HCPCS J3101
Hospital Revenue Code	636
Min. Negotiated Rate	$171.94
Max. Negotiated Rate	$10,143.29
Rate for Payer: AlohaCare Medicaid	$5,228.50
Rate for Payer: AlohaCare Medicare	$3,241.67
Rate for Payer: Cash Price	$6,274.20
Rate for Payer: Cash Price	$6,274.20
Rate for Payer: Devoted Health Medicare	$3,555.38
Rate for Payer: Hawaii Medical Service Association ABD	$171.94
Rate for Payer: Hawaii Medical Service Association Commercial	$246.80
Rate for Payer: Hawaii Medical Service Association Medicare	$3,241.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$171.94
Rate for Payer: Hawaii Western Management Group Commercial	$9,934.15
Rate for Payer: Health Management Network Commercial	$8,888.45
Rate for Payer: Humana Medicare	$3,241.67
Rate for Payer: Kaiser Permanente Commercial	$9,411.30
Rate for Payer: Kaiser Permanente Medicaid	$5,333.07
Rate for Payer: Kaiser Permanente Medicare	$3,241.67
Rate for Payer: MDX Hawaii PPO	$10,143.29
Rate for Payer: Ohana Health Plan Medicaid	$3,241.67
Rate for Payer: Ohana Health Plan Medicare	$3,241.67
Rate for Payer: UnitedHealthcare Medicaid	$6,274.20
Rate for Payer: UnitedHealthcare Medicare	$3,241.67
Rate for Payer: University Health Alliance Commercial	$7,622.11

TENECTEPLASE 50 MG INTRAVENOUS SOLUTION [206762]

Facility

$10,457.00

Service Code	HCPCS J3101
Hospital Revenue Code	250
Min. Negotiated Rate	$8,888.45
Max. Negotiated Rate	$10,143.29
Rate for Payer: Cash Price	$6,274.20
Rate for Payer: Health Management Network Commercial	$8,888.45
Rate for Payer: Kaiser Permanente Commercial	$9,411.30
Rate for Payer: MDX Hawaii PPO	$10,143.29

TENMO ACT 20X11 BIOPSY

Facility

$234.00

Hospital Revenue Code	272
Min. Negotiated Rate	$198.90
Max. Negotiated Rate	$226.98
Rate for Payer: Cash Price	$140.40
Rate for Payer: Health Management Network Commercial	$198.90
Rate for Payer: Kaiser Permanente Commercial	$210.60
Rate for Payer: MDX Hawaii PPO	$226.98

TENMO ACT 20X11 BIOPSY

Facility

$234.00

Hospital Revenue Code	272
Min. Negotiated Rate	$72.54
Max. Negotiated Rate	$226.98
Rate for Payer: AlohaCare Medicaid	$117.00
Rate for Payer: AlohaCare Medicare	$72.54
Rate for Payer: Cash Price	$140.40
Rate for Payer: Devoted Health Medicare	$79.56
Rate for Payer: Hawaii Medical Service Association Medicare	$72.54
Rate for Payer: Hawaii Western Management Group Commercial	$222.30
Rate for Payer: Health Management Network Commercial	$198.90
Rate for Payer: Humana Medicare	$72.54
Rate for Payer: Kaiser Permanente Commercial	$210.60
Rate for Payer: Kaiser Permanente Medicaid	$119.34
Rate for Payer: Kaiser Permanente Medicare	$72.54
Rate for Payer: MDX Hawaii PPO	$226.98
Rate for Payer: Ohana Health Plan Medicaid	$72.54
Rate for Payer: Ohana Health Plan Medicare	$72.54
Rate for Payer: UnitedHealthcare Medicare	$72.54
Rate for Payer: University Health Alliance Commercial	$170.56

TENO BIO-COMP AR-1662BCC-7

Facility

$1,866.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,044.96
Max. Negotiated Rate	$1,810.02
Rate for Payer: Cash Price	$1,119.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,306.20
Rate for Payer: Health Management Network Commercial	$1,586.10
Rate for Payer: Kaiser Permanente Commercial	$1,679.40
Rate for Payer: MDX Hawaii PPO	$1,810.02
Rate for Payer: University Health Alliance Commercial	$1,044.96

TENO BIO-COMP AR-1662BCC-7

Facility

$1,866.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$578.46
Max. Negotiated Rate	$1,810.02
Rate for Payer: AlohaCare Medicaid	$933.00
Rate for Payer: AlohaCare Medicare	$578.46
Rate for Payer: Cash Price	$1,119.60
Rate for Payer: Devoted Health Medicare	$634.44
Rate for Payer: Hawaii Medical Service Association Medicare	$578.46
Rate for Payer: Hawaii Western Management Group Commercial	$1,306.20
Rate for Payer: Health Management Network Commercial	$1,586.10
Rate for Payer: Humana Medicare	$578.46
Rate for Payer: Kaiser Permanente Commercial	$1,679.40
Rate for Payer: Kaiser Permanente Medicaid	$951.66
Rate for Payer: Kaiser Permanente Medicare	$578.46
Rate for Payer: MDX Hawaii PPO	$1,810.02
Rate for Payer: Ohana Health Plan Medicaid	$578.46
Rate for Payer: Ohana Health Plan Medicare	$578.46
Rate for Payer: UnitedHealthcare Medicare	$578.46
Rate for Payer: University Health Alliance Commercial	$1,044.96

TERAZOSIN 1 MG CAPSULE [14550]

Facility

$6.00

Service Code	NDC 50268076411
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: MDX Hawaii PPO	$5.82

TERAZOSIN 1 MG CAPSULE [14550]

Facility

$6.00

Service Code	NDC 59746038306
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: MDX Hawaii PPO	$5.82

TERAZOSIN 1 MG CAPSULE [14550]

Facility

$6.00

Service Code	NDC 50268076411
Hospital Revenue Code	637
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$5.82
Rate for Payer: AlohaCare Medicaid	$3.00
Rate for Payer: AlohaCare Medicare	$1.86
Rate for Payer: Cash Price	$3.60
Rate for Payer: Devoted Health Medicare	$2.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1.86
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Humana Medicare	$1.86
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: Kaiser Permanente Medicare	$1.86
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: Ohana Health Plan Medicaid	$1.86
Rate for Payer: Ohana Health Plan Medicare	$1.86
Rate for Payer: UnitedHealthcare Medicare	$1.86
Rate for Payer: University Health Alliance Commercial	$4.37

TERAZOSIN 1 MG CAPSULE [14550]

Facility

$6.00

Service Code	NDC 59746038306
Hospital Revenue Code	637
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$5.82
Rate for Payer: AlohaCare Medicaid	$3.00
Rate for Payer: AlohaCare Medicare	$1.86
Rate for Payer: Cash Price	$3.60
Rate for Payer: Devoted Health Medicare	$2.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1.86
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Humana Medicare	$1.86
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: Kaiser Permanente Medicare	$1.86
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: Ohana Health Plan Medicaid	$1.86
Rate for Payer: Ohana Health Plan Medicare	$1.86
Rate for Payer: UnitedHealthcare Medicare	$1.86
Rate for Payer: University Health Alliance Commercial	$4.37

TERAZOSIN 2 MG CAPSULE [14551]

Facility

$6.00

Service Code	NDC 59746038406
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: MDX Hawaii PPO	$5.82

TERAZOSIN 2 MG CAPSULE [14551]

Facility

$6.00

Service Code	NDC 59746038406
Hospital Revenue Code	637
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$5.82
Rate for Payer: AlohaCare Medicaid	$3.00
Rate for Payer: AlohaCare Medicare	$1.86
Rate for Payer: Cash Price	$3.60
Rate for Payer: Devoted Health Medicare	$2.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1.86
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Humana Medicare	$1.86
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: Kaiser Permanente Medicare	$1.86
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: Ohana Health Plan Medicaid	$1.86
Rate for Payer: Ohana Health Plan Medicare	$1.86
Rate for Payer: UnitedHealthcare Medicare	$1.86
Rate for Payer: University Health Alliance Commercial	$4.37

TERAZOSIN 5 MG CAPSULE [14553]

Facility

$6.00

Service Code	NDC 59746038506
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: MDX Hawaii PPO	$5.82

Know your out-of-pocket cost for care.

All Charges